What is the management of an 11mm meningioma in the left Sylvian fissure?

From the Guidelines

The management of an 11mm meningioma in the left Sylvian fissure typically involves observation with serial imaging and clinical monitoring, as the tumor is small (< 30 mm) [ 1 ].

Key Considerations

• The tumor size is small (< 30 mm), which suggests a more conservative approach [ 1 ].
• The location of the tumor in the left Sylvian fissure is important to consider, as it may be accessible for surgery if needed [ 1 ].
• The patient's symptomatic status is crucial in determining the management approach, and since the patient is asymptomatic, observation is preferred [ 1 ].

Management Approach

• Observation with serial imaging, such as MRI scans, every 6-12 months to monitor tumor growth and assess for any changes in symptoms or neurological status [ 1 ].
• Surgery may be considered if the tumor is accessible and the patient develops symptoms or if there is significant growth on serial imaging [ 1 ].
• Radiotherapy (RT) may be considered if the tumor is WHO grade 3 or if there is incomplete resection [ 1 ].

Additional Considerations

• Multidisciplinary input for treatment planning is recommended if feasible [ 1 ].
• The median growth rate for meningiomas is 4 mm per annum, which should be taken into account when monitoring the tumor [ 1 ].

From the Research

Management of 11mm Meningioma in the Left Sylvian Fissure

The management of an 11mm meningioma in the left Sylvian fissure can be approached in several ways, considering the tumor's size, location, and potential impact on the patient's quality of life.

• The tumor is relatively small, and as noted in 2, most incidental meningiomas are small and demonstrate indolent behavior, suggesting that immediate intervention may not be necessary.
• However, the location of the tumor in the Sylvian fissure is significant, as tumors in this region can cause seizures or other neurological deficits, as reported in 3.
• The European Association of Neuro-Oncology (EANO) guidelines, discussed in 4, recommend a watch-and-scan strategy for asymptomatic or elderly patients with small meningiomas, but also suggest that surgical intervention may be necessary for definitive diagnosis and treatment.
• Radiotherapy, including stereotactic radiosurgery or fractionated radiotherapy, is also a viable treatment option for meningiomas, particularly for inoperable or recurrent tumors, as outlined in 5.
• Surgical management of skull base meningiomas, including those in the Sylvian fissure, is complex and requires careful consideration of the tumor's relationship to surrounding neurovascular structures, as discussed in 6.

Treatment Options

• Watch-and-scan strategy: Regular imaging and clinical follow-up to monitor tumor growth and development of symptoms.
• Surgical intervention: Gross total resection of the tumor, including involved dura, for definitive diagnosis and treatment.
• Radiotherapy: Stereotactic radiosurgery or fractionated radiotherapy for inoperable or recurrent tumors.
• Combination therapy: Surgery and radiotherapy may be used in combination to achieve optimal treatment outcomes.

Considerations

• Tumor size and location: The 11mm size of the tumor and its location in the Sylvian fissure are important factors in determining the best course of treatment.
• Patient age and medical comorbidities: The patient's overall health and age may influence the decision to pursue surgical or radiotherapeutic treatment.
• Risk of treatment-related adverse events: The potential risks and benefits of each treatment option must be carefully weighed and discussed with the patient.